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The health of India’s population has witnessed significant improvements over the past two decades. The infant mortality rate (IMR) has fallen from over 71 per 1000 live births in 1998 to 31 per 1000 live births in 2017. Maternal mortality has declined even more dramatically, from 540 maternal deaths in 1998 to 170 maternal deaths per 100 000 live births in 2013, a fall of close to 70%.1 These reductions in mortality have been accompanied by a major shift in India’s disease burden. Non-communicable diseases (NCDs) such as heart disease, diabetes and cancer, which accounted for 30% of disease burden in 1990, represented over 55% of the disease burden in 2016, while communicable, maternal and child diseases accounted for nearly one-third of the burden.2 Addressing these rapid shifts requires a fit-for-purpose health system to move towards Universal Health Coverage (UHC). The Government of India launched the Ayushman Bharat Programme in 2018, a potentially important step in this direction with two major components. First, primary healthcare improvements through investment in 150 000 Health and Wellness Centres (HWCs) and a new cadre of mid-level health providers, accredited for primary care and public health competencies. Over 38 000 HWCs were functional as of April 2020.3 4 Second, an insurance mechanism, the Pradhan Mantri Jan Arogya Yojana (PM-JAY), which aims to cover hospital-level care in both public and private hospitals for over 100 million poor families. PM-JAY has reimbursed over 9.5 million hospitalisation events since its launch in September 20185 Both these components are largely financed through general …
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